| NPI | 1114400744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01854300) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-09-29 |