| NPI | 1700037108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01488900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026971) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2016-02-25 |