| NPI | 1578650750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027415) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01268300) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2008-01-02 |