| NPI | 1205525326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014714) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02174700) |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2026-05-13 |