| NPI | 1609581412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC PT.12347PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02114800) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2024-05-28 |