| NPI | 1174982425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01513200) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: NJ 40QA01513200) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2021-05-20 |