| NPI | 1912045428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025569-0) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01296500) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2012-06-15 |