| NPI | 1538498217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA0q1559200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022243) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2026-04-14 |