| NPI | 1649661646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01719600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036972) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2020-07-23 |