| NPI | 1124816566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA01971200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 000025355) |
| Enumeration Date | 2025-04-26 |
| Last Update Date | 2025-04-26 |