| NPI | 1295042174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01432100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62 032091) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2013-01-23 |