| NPI | 1184934812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01341200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 019509) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |