| NPI | 1700853835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01162200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017064) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2013-03-12 |