| NPI | 1629742044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02024700) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2022-04-13 |