| NPI | 1366402729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01197100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027755) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2020-03-16 |