| NPI | 1588702088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40qa01271700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 024830) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2021-04-22 |