| NPI | 1942203328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34697) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA006934000) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2010-03-25 |