| 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 |