| NPI | 1548500275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01442500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034959) |
| Enumeration Date | 2013-02-16 |
| Last Update Date | 2013-02-16 |