| NPI | 1114233723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 031821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01320900) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2016-05-25 |