| NPI | 1912063850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01058500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 024102-1) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2008-09-05 |