| NPI | 1114706082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048827-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02095200) |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2023-09-28 |