| NPI | 1033466586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29094) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01448800) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2014-08-21 |