| NPI | 1164099610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01936500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA01936500) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2021-10-07 |