| NPI | 1689063778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01593100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038480) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2025-05-08 |