| NPI | 1326149675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA 010326) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6205) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2009-09-16 |