| NPI | 1215907449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027028-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01277900) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2015-04-03 |