| NPI | 1013271816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01235800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034395) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2012-10-01 |