| NPI | 1528437209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 035527) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01869000) |
| 225100000X Physical Therapist (Licence: CA 296808) | |
| 225100000X Physical Therapist (Licence: PA PT026977) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2019-08-28 |