| NPI | 1265801443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01970500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022411) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2020-11-25 |