| NPI | 1023793502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031528) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02232600) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2024-01-06 |