| NPI | 1356678965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01501500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62 029884) |
| 225100000X Physical Therapist (Licence: PA PT020227) | |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2021-08-20 |