| NPI | 1730141615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00918000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 021876) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2018-01-25 |