| NPI | 1578710778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01284300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62 030380) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2013-04-29 |