| NPI | 1093213266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 40qa01766800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01766800) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2024-07-29 |