| NPI | 1487743613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01219800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA01219800) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2009-08-14 |