| NPI | 1255517710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 017930) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01130400) |
| 225X00000X Occupational Therapist (Licence: NY 012347) | |
| 225X00000X Occupational Therapist (Licence: NJ 46TR00382200) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2008-01-15 |