| NPI | 1962442418 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00990400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017078) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2010-10-27 |