| NPI | 1942675731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4899) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NJ 40QA01351000) | |
| Enumeration Date | 2015-12-06 |
| Last Update Date | 2023-01-27 |