| NPI | 1588843189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 35118) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ PT40QA00804200) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2022-04-19 |