| NPI | 1083157564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01700500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040361-1) |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2019-12-30 |