| NPI | 1033626791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 18051) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01762300) |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-07-13 |