| NPI | 1730222829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ PT40QA01129300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 024922) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-04-23 |