| NPI | 1598954679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist Neurology (Licence: MA 21126) |
| Additional Taxonomies | 2251N0400X Physical Therapist Neurology (Licence: NJ 40QA01146300) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2023-08-29 |