| NPI | 1538357744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 40QA01153600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01153600) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2025-03-10 |