| NPI | 1215950845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01155800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 020989) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-07-30 |