| NPI | 1245422872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD439103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00503900) |
| 207Q00000X Family Medicine (Licence: CT 046146) | |
| 207Q00000X Family Medicine (Licence: NH 13919) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2010-02-25 |