| NPI | 1750426409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT010629L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00643800) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-11-20 |