| NPI | 1578978375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 4OQA1561500) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00249100) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2020-02-19 |