| NPI | 1013101344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 029382) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01249900) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2026-01-22 |