| NPI | 1689750069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA4003741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 018834-1) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2020-01-30 |