| NPI | 1912037367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01442300) |
| 225100000X Physical Therapist (Licence: NY 0253261) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-01-02 |