| NPI | 1134264732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40qa01116800) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NJ 25MZ00084600) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-10-24 |