| NPI | 1457420440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021695) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01224300) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2024-09-24 |