| NPI | 1427293489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01293800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030269) |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2019-11-21 |