| NPI | 1811100670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA009545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 021578-1) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |