| NPI | 1649359480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01079200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016612) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2026-02-18 |