| NPI | 1578753406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 4OQA01198000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40qa01198000) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2022-09-19 |