| NPI | 1295150282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00827800) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA AK001055) |
| 225100000X Physical Therapist (Licence: PA PT006441L) | |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2023-01-13 |