| NPI | 1881743284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA01215200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030827) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2016-01-28 |