| NPI | 1982264750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296734) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01775900) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2019-09-02 |