| NPI | 1912452376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01753100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039731) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2025-01-06 |