| NPI | 1528370012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01482400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032531-1) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2024-04-05 |