| NPI | 1063885796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039329) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01636400) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2021-04-08 |