| NPI | 1477827053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01711800) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 033784-1) |
| 225100000X Physical Therapist (Licence: TX 1270407) | |
| 225100000X Physical Therapist (Licence: NY 033784) | |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2017-11-30 |