| NPI | 1649435702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01294800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019439) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2017-03-13 |