| NPI | 1073897799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1209577) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029235) |
| 225100000X Physical Therapist (Licence: NJ 40QA01281700) | |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2011-09-29 |