| NPI | 1992904312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40qa01199600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 22093) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2007-10-22 |