| NPI | 1992755607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA01048000) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 024900) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-02-26 |