| NPI | 1356746275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01700400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 40QA01700400) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2019-10-23 |