| NPI | 1831868280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ CP024828T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10877) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2023-09-20 |