| NPI | 1154966828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01935100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045178) |
| Enumeration Date | 2019-11-17 |
| Last Update Date | 2024-08-21 |