| NPI | 1265566103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 30109) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 30109) |
| 225100000X Physical Therapist (Licence: NJ 40QA01319000) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NJ 40QA01319000) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-01-29 |