| NPI | 1730841768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050225) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02034100) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2023-06-12 |