| NPI | 1487763256 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00971300) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-03-07 |