| NPI | 1851607428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01363400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25175) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2017-08-04 |