| NPI | 1871617951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36714) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NJ 40QA01234600) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-12-12 |