| NPI | 1114563269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01904600) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2023-09-21 |