| NPI | 1467518696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QAO835800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0186861) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2007-07-08 |