| NPI | 1114736592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 053306-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02291100) |
| Enumeration Date | 2024-12-31 |
| Last Update Date | 2024-12-31 |