| NPI | 1609060144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01253700) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2025-07-22 |