| NPI | 1497936140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01635300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029801) |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2024-01-26 |