| NPI | 1770924128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01578100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0331661) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2018-03-17 |