| NPI | 1649600792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0012097) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01342700) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2014-05-15 |