| NPI | 1548451503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QAO1336000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032586) |
| 225200000X Physical Therapy Assistant | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2020-04-03 |