| NPI | 1306230578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00981800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015455) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2015-03-25 |