| NPI | 1699707562 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01828200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017699) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-06-05 |