| NPI | 1972500544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16417) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA08473) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2014-02-12 |