| NPI | 1104248350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01655200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009978) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2024-06-24 |