| NPI | 1487691416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 021302-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00972700) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2009-11-10 |