| NPI | 1477576551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00785300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA07853) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-09-10 |