| NPI | 1902423510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01931600) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2024-04-23 |