| NPI | 1730120940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00665400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0150041) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2009-02-03 |