| NPI | 1316940638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00376400) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA00376400) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2014-01-29 |