| NPI | 1841273992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00499300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10001525) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2013-04-22 |