| NPI | 1508022674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01291200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030268-1) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2026-06-27 |