| NPI | 1831327741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01371900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019996) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2019-02-05 |