| NPI | 1023451929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01491700) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2015-03-09 |