| NPI | 1063641132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01316900) |
| 225100000X Physical Therapist (Licence: MD 23540) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2014-07-22 |