| NPI | 1952739377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01779800) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2020-01-09 |