| NPI | 1316166960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT002679-L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00109000) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |