| NPI | 1013334564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01544800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10003118) |
| Enumeration Date | 2014-03-22 |
| Last Update Date | 2014-11-11 |