| NPI | 1700333424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01721900) |
| Enumeration Date | 2016-09-10 |
| Last Update Date | 2021-11-11 |