| NPI | 1578841664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032495) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008702) |
| 225100000X Physical Therapist (Licence: MA 19160) | |
| 225100000X Physical Therapist (Licence: NJ 40QA01548300) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2021-04-09 |