| NPI | 1740658285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4671) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01628500) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2021-09-29 |