| NPI | 1790324085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA01660700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: QA01660700) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2025-05-28 |