| NPI | 1942539267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01371300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070017123) |
| 225100000X Physical Therapist (Licence: NY 9701978) | |
| 225100000X Physical Therapist (Licence: CT 008642) | |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2019-01-07 |