| NPI | 1487927091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01525700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002805) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2023-11-24 |