NPI | 1255802898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01835900) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25774) |
Enumeration Date | 2018-12-07 |
Last Update Date | 2024-05-02 |