| NPI | 1932643848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01710300) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2019-06-05 |