| NPI | 1558892026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01843300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041217) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2023-04-07 |