| NPI | 1396808747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 38279) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA01144500) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-10-05 |