| NPI | 1447012307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02234100) |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2025-02-01 |