| 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 |