| NPI | 1205169331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01330700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031571) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2016-12-16 |