| NPI | 1659740447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039438-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01649300) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2021-04-12 |