| NPI | 1184722951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00982400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0242161) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-06-19 |