| NPI | 1730956491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020245) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02227500) |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2024-12-23 |