| NPI | 1992734602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 33127) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01013600) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2009-03-24 |