| NPI | 1073540860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT3488) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 40QA01061200) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2008-11-11 |