| NPI | 1164579579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00982700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA009827) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2010-04-30 |