| NPI | 1427290329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01356400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 021289) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2011-11-21 |