| NPI | 1124196407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00969800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 023194) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2007-07-08 |