| NPI | 1346296860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01019800) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA01049800) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2008-09-12 |