| NPI | 1730738402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01923000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044758) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2022-12-01 |