| NPI | 1093140741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036835-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01516000) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2016-02-03 |