| 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 |