| NPI | 1881060465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01693100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 09183) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2018-11-08 |