| NPI | 1285785790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00279000) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ qa002790) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2020-07-14 |