| NPI | 1811655988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032740) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02062000) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2025-05-12 |