| NPI | 1205582269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29384) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02074900) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2023-08-03 |