| NPI | 1558338764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA0053400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-009193-E) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2017-01-05 |