| NPI | 1629130794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01274300) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA01274300) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2025-04-24 |