| NPI | 1780976225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030398) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NJ 40QA01787900) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2022-10-26 |