| NPI | 1508078940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00815200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26096) |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2020-04-07 |