| NPI | 1821718164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02109200) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-03-06 |