| NPI | 1487263299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01924300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 40qa01924300) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-10-23 |