| NPI | 1982838561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012303) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01285900) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2016-06-01 |