| NPI | 1639684723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01731900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038952) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2022-08-29 |