| NPI | 1144664350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036717) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01523800) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2016-07-06 |