| NPI | 1538281944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01114500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 018879-1) |
| 225100000X Physical Therapist (Licence: HI PT-1633) | |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2007-07-08 |