| NPI | 1639860117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02177000) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2024-08-09 |