| NPI | 1033721311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01948600) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2023-10-30 |