| NPI | 1164648481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NJ 40QA00978900) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 019510) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2013-09-14 |