| NPI | 1295295913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01846900) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| 2251H1200X Physical Therapist, Hand | |
| 2251N0400X Physical Therapist, Neurology | |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-06-13 |