| NPI | 1497727291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032593-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01950300) |
| 225100000X Physical Therapist (Licence: CT 007633) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2021-09-20 |