| NPI | 1952795148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01588300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0387341) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2015-07-12 |