| NPI | 1730631433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01700100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62006) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2016-10-28 |