| NPI | 1083732796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00810200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT6503) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2019-08-22 |