| NPI | 1942781315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT297472) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01815100) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2023-01-06 |