| NPI | 1073150553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036459) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01848000) |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2019-12-04 |