| NPI | 1063475721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01020500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017215) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2009-12-30 |