| NPI | 1922554989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01691200) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2024-03-04 |