| NPI | 1467632919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 62 033294) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01265000) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2011-12-29 |