| NPI | 1952672636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01353100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020569) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-12-20 |