| NPI | 1558842823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27586) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01801600) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2025-01-06 |