| NPI | 1013532084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01928900) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 40QA01928900) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-10-21 |