| NPI | 1801891205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01378900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT20763) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2011-11-22 |