| NPI | 1316032238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01507000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC05295) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-11-21 |