NPI | 1114247699 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01103700) |
Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
Enumeration Date | 2010-06-07 |
Last Update Date | 2020-09-16 |