| NPI | 1376411512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02240900) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA02240900) |
| Enumeration Date | 2025-10-28 |
| Last Update Date | 2025-11-14 |