| NPI | 1609285121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01861500) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00264500) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2026-01-03 |