| NPI | 1114263597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01375500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021668) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2012-12-12 |