| NPI | 1821339102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01609800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035472) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2021-12-30 |