| NPI | 1316523228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ CP050307T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 19809) |
| 225100000X Physical Therapist (Licence: MD 28361) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-01-26 |