| NPI | 1669750584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0382441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01402100) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2019-04-16 |