| NPI | 1144485319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018299-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA01277600) |
| Enumeration Date | 2008-07-27 |
| Last Update Date | 2008-07-27 |