| NPI | 1699111716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01474100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035413-1) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |