| NPI | 1487942025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024343) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01406200) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2016-01-20 |