| NPI | 1821232604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01867100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 021368) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2021-12-01 |