| NPI | 1336739903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29923) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01987800) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2024-05-27 |