| NPI | 1902578511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01889900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028246) |
| 225100000X Physical Therapist (Licence: CA 299609) | |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2021-10-01 |