| NPI | 1992282503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01795400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026943) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2020-04-16 |