| NPI | 1518150606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01391100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT3289) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2014-04-09 |