| NPI | 1891841466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01236200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62-02889) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-12-20 |