| NPI | 1699704080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01146500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT008648L) |
| 225100000X Physical Therapist (Licence: PA DAPT003483) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-04-01 |