| NPI | 1578854394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01392400) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA01392400) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2023-05-05 |