| NPI | 1346351160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01673600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT001140) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2017-03-31 |