| NPI | 1609440361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02065600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029668) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2023-12-28 |