| NPI | 1669791521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01361500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029690-1) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2024-05-06 |