| NPI | 1487695961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00862800) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NJ 25MZ00070600) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-06-29 |