| NPI | 1659885747 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40qa01045200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016024) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2018-03-17 |