| NPI | 1902214117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038631-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01833800) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2020-03-17 |