| NPI | 1396012795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01480400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37032) |
| 225100000X Physical Therapist (Licence: NY 032987) | |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2019-05-31 |