| NPI | 1780817213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01067900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 022202) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-09-01 |