| NPI | 1487075370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 21595) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01523100) |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2020-08-17 |