| NPI | 1134797442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02006900) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2023-11-28 |