| NPI | 1750322715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 023019) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01158900) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-02-10 |