| NPI | 1699179432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01861700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027657-1) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2020-08-13 |