| NPI | 1508502352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02262800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38415) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2024-08-02 |