| NPI | 1053877860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 044048) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01844300) |
| Enumeration Date | 2019-02-17 |
| Last Update Date | 2019-06-19 |