| NPI | 1073783544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022816-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01354600) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2024-12-11 |