| NPI | 1962958041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21411) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01679900) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2025-05-20 |