| NPI | 1033681465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043872-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40qa02049000) |
| Enumeration Date | 2018-12-25 |
| Last Update Date | 2022-07-18 |