| NPI | 1467020404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ CP057898T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029512) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2026-08-14 |