| NPI | 1316117385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025776-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01115700) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2017-04-11 |