| NPI | 1215419593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02053300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0160837) |
| Enumeration Date | 2018-09-03 |
| Last Update Date | 2023-05-12 |