| NPI | 1447028915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT03196) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02228900) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2024-01-21 |