| NPI | 1285677344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40qa01115100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 25903) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-10-28 |