| NPI | 1821374653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 62 023652) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01048100) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |