| NPI | 1801279690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01857000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024680) |
| 225100000X Physical Therapist (Licence: PA TPT021709) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2019-07-25 |