| NPI | 1861963126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043773) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01835100) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2021-04-22 |