| NPI | 1457017055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02053100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 13224) |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2026-03-11 |