| NPI | 1841224839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01427700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007772) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2011-12-12 |