| NPI | 1891573507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02245500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 050771-01) |
| 225100000X Physical Therapist (Licence: NC P22610) | |
| 225100000X Physical Therapist (Licence: TX 1382367) | |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2024-04-27 |