| NPI | 1164467098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 40QA01042700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA pt016257) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2024-12-12 |