| NPI | 1346346293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40qa01108500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017878-1) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-09 |