| NPI | 1679971204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01790400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037112) |
| Enumeration Date | 2014-12-13 |
| Last Update Date | 2021-08-19 |