| NPI | 1295809135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00997600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 022156-1) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2018-09-08 |