| NPI | 1184142689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26932) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042189) |
| 225100000X Physical Therapist (Licence: NJ 40QA01759200) | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2024-12-18 |