| NPI | 1679973481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01573500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT033785) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2026-01-27 |