| NPI | 1679042816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 043768) |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2023-02-02 |