| NPI | 1245229194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01111200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016324L) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2019-04-04 |