| NPI | 1841707700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02278900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23363) |
| Enumeration Date | 2018-01-01 |
| Last Update Date | 2024-08-22 |