| NPI | 1518999085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NJ 18KT00636900) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-12-04 |