| NPI | 1336620681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01817700) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2022-11-11 |