| NPI | 1609275973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27075) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01847900) |
| 225100000X Physical Therapist (Licence: NY 037894-1) | |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2019-06-25 |