| NPI | 1265133532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02133600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023863) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-03-14 |