| NPI | 1013979830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01200700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017870) |
| 225100000X Physical Therapist (Licence: DE J1-0001999) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2010-03-08 |