| NPI | 1508132010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027029) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01299200) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-03-29 |