| NPI | 1912423971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT026067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01750500) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2024-02-06 |