| NPI | 1336175488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00955800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT012862L) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-04-01 |