| NPI | 1124677182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01885800) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2021-06-15 |