| NPI | 1700846748 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00485800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT009524L) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2015-08-11 |