| NPI | 1801563390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014682) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02035800) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA02035800) | |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2023-04-17 |