| NPI | 1164741609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01481200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030019) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2023-01-26 |