| NPI | 1346850419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044187) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02337500) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2025-09-11 |