| NPI | 1013961523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00175100) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA00175100) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2019-12-30 |