| NPI | 1780609438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01200200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 019944-1) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-09-18 |