| NPI | 1578234134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030123) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02008500) |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2022-02-09 |