| NPI | 1669241584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 40QA02179100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 307891) |
| Enumeration Date | 2023-12-20 |
| Last Update Date | 2025-06-05 |