| NPI | 1710044169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00766700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017906-1) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-02-07 |