| NPI | 1215050554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00997700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA pt011774l) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2024-09-11 |