| NPI | 1124578646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01700200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025315) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2019-06-26 |