NPI | 1275802126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01428200) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021635) |
Enumeration Date | 2011-12-21 |
Last Update Date | 2011-12-21 |