| NPI | 1134556392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01855800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036509) |
| 225100000X Physical Therapist (Licence: PA PT029586) | |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2025-05-15 |