| NPI | 1639111909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01732100) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 017594) |
| 225100000X Physical Therapist (Licence: NY 017594) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2019-01-03 |