| NPI | 1154933869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01931700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045969) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2022-07-14 |