| NPI | 1063424802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 016746) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QAO673200) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2023-03-22 |