| NPI | 1578105599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01887100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0004141) |
| 225100000X Physical Therapist (Licence: PA PT028142) | |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2021-05-07 |