| NPI | 1619001823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 010624-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00235000) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-06-16 |