| NPI | 1134555220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023077) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01520700) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2021-03-11 |