| NPI | 1356530661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11519) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00944300) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA00944300) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2009-09-21 |