| NPI | 1528343076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01474800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033846) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2013-02-14 |