| NPI | 1518375617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01703300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 10224) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2016-11-21 |