| NPI | 1114460219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01826200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.022982) |
| 225100000X Physical Therapist (Licence: DE J1-0003603) | |
| 225100000X Physical Therapist (Licence: NY 041468) | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2020-01-13 |