| NPI | 1265488910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 12086) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01453700) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2012-10-29 |