| NPI | 1285035410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12988-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01571100) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2015-05-13 |