| NPI | 1891003273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01304200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029041) |
| Enumeration Date | 2010-09-19 |
| Last Update Date | 2014-04-01 |