| NPI | 1487621173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01093000) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2008-02-12 |