| NPI | 1467068809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01948700) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2022-01-28 |