| NPI | 1124450440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 035800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01651000) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2025-06-17 |