| NPI | 1386869022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015514) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00734700) |
| 225100000X Physical Therapist (Licence: IL 070-010458) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |