| NPI | 1972646735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40qa0090300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00903000) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2019-01-25 |