| NPI | 1902545015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02089700) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-06-07 |