| NPI | 1710176854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01273200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 29182) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2023-01-15 |