| NPI | 1053744698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA01535000) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2014-02-11 |