| NPI | 1326674219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01951600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 5564) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-10-07 |