| NPI | 1801929427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01264800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029203) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2018-08-06 |