| NPI | 1295134468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01805500) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00311300) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2020-02-13 |