| NPI | 1710029657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A110971) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 021737) |
| 207Q00000X Family Medicine (Licence: NJ 223548695) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2026-06-11 |