| NPI | 1699189779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02157900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023587) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2023-09-28 |