| NPI | 1972076891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01795100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27034) |
| 225100000X Physical Therapist (Licence: MA 23664) | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2022-11-08 |