| NPI | 1174773626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01332900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18083) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2009-11-09 |