| NPI | 1861448557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT0007862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00648200) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2015-03-24 |