| NPI | 1851362677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 008334-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 002518) |
| 225100000X Physical Therapist (Licence: NJ QA02200) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-12-12 |