| NPI | 1801140173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034867-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40qa01447000) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2012-11-07 |