| NPI | 1750678058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1208938) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40Q01030900) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-07-07 |