| NPI | 1639506017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0366561) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02006200) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2022-10-19 |