| NPI | 1932386729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030017-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02028700) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2021-08-12 |