| NPI | 1538029509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MA 89026) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02413200) |
| Enumeration Date | 2025-11-13 |
| Last Update Date | 2026-05-19 |