| NPI | 1154991412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02007200) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2023-07-05 |