| NPI | 1417707233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02206200) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-09-06 |