| NPI | 1821866260 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02106100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032202) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2024-10-30 |