| NPI | 1386847432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01278300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017003) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2021-10-05 |