| NPI | 1700069564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 40qa00109200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40qa00109200) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2008-02-26 |