| NPI | 1215361647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01931000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036653) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2020-07-22 |