| NPI | 1356411516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01127200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA MA16404) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |