| NPI | 1326199316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-013539) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00849800) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2019-10-20 |