| NPI | 1477562494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00981600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 018570) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2019-10-22 |