| NPI | 1215279815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01997800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036118) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2021-08-19 |