| NPI | 1912946948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016014) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01013100) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2021-07-13 |