| NPI | 1679872154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01496600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033531-1) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2017-11-22 |