| NPI | 1851634521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036045) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01490500) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2025-06-09 |