| NPI | 1427655166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 053239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01938500) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2024-10-23 |