| NPI | 1528776994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030933) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NJ 40QA02136400) | |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-12-05 |