| NPI | 1881357861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 1881357861) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT029965) |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2023-11-30 |