| NPI | 1386668424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0040241) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01297100) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-09-15 |