| NPI | 1508866906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00473900) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: NJ 40QA00473900) |
| 225100000X Physical Therapist (Licence: PA PT000539E) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2021-01-20 |