| NPI | 1053073437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02050400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 13837) |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2024-12-20 |