| NPI | 1528549185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01790800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043223) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2020-08-21 |