| NPI | 1043096845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01944000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP029811T) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2024-05-20 |