| NPI | 1598785693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034665-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ PT 40QA01197700) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-02-25 |