| NPI | 1376309468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12447) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NJ 40QA02237300) | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-08-08 |