| NPI | 1366164782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 28296) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02124100) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-06-30 |