| NPI | 1508145277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01408500) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2020-01-15 |