| NPI | 1396598298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02172000) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA02172000) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA02172000) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NJ 40QA02172000) | |
| Enumeration Date | 2024-04-09 |
| Last Update Date | 2024-04-09 |