| NPI | 1154629301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01120700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026136) |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2011-03-10 |