| NPI | 1013342856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA1422000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033949) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2013-09-12 |