| NPI | 1225436868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040087) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01586800) |
| Enumeration Date | 2014-12-14 |
| Last Update Date | 2021-04-21 |