| NPI | 1396266813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA1759100) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CO PTL.0014801) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2025-08-01 |