| NPI | 1255661278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020344) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01353700) |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2016-10-19 |