NPI | 1689610859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01132100) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 023966) |
Enumeration Date | 2006-06-22 |
Last Update Date | 2018-12-05 |