| NPI | 1669140901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02017300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25087) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2021-09-01 |