| NPI | 1710296231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01378400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020699) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2020-04-16 |