| NPI | 1982673646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 024223-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01147300) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2008-12-09 |