| NPI | 1598303810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0004072) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01812500) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2019-12-17 |