| NPI | 1932231594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018882) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17758) |
| 225100000X Physical Therapist (Licence: NJ 40QA01232200) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-10-08 |