| NPI | 1174544365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00747800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT005395L) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2008-01-08 |