| NPI | 1225177801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01130200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026260) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2025-03-13 |