| NPI | 1639266190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00781300) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA00781300) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2021-09-24 |