| NPI | 1164082699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045713-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01858400) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-01-30 |