| NPI | 1962784512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA00954700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT013625L) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2011-09-09 |