| NPI | 1093259046 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01712400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 32062) |
| Enumeration Date | 2016-12-10 |
| Last Update Date | 2017-01-31 |