| NPI | 1093888331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01479000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027456) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2013-01-02 |