| NPI | 1942389739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01083300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 021017-1) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-11-15 |