| NPI | 1073864724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 012736) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01326400) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |