| NPI | 1326797325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02263900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014519) |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2024-08-21 |