| NPI | 1861893273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01612800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 130292014) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2020-07-10 |