| NPI | 1467217430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02243200) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2025-03-05 |