| NPI | 1093883845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 015682) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 06504) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-07-08 |