| NPI | 1356591986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01592700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031521) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2015-03-24 |