| NPI | 1366758120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01383000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029822-1) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2017-05-10 |