| NPI | 1083046304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01771700) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE009558) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2021-10-18 |