| NPI | 1013003680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0059492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID RPT1698) |
| 225100000X Physical Therapist (Licence: NJ 5386) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |