| NPI | 1619514841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA01986600) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 296802) |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2021-10-08 |