| NPI | 1639848716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029621) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02044200) |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2022-08-04 |