| NPI | 1114144078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016078) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40qa01370500) |
| 225100000X Physical Therapist (Licence: NY 032081-1) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-02-10 |