| NPI | 1225099039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01573700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 013161) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-07-07 |