| NPI | 1124431937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 26323) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00929600) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-06-09 |