| NPI | 1669912747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025881) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01719700) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-05-10 |