NPI | 1851173421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: DC 210002401) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA02118200) |
Enumeration Date | 2023-10-18 |
Last Update Date | 2024-01-04 |