| NPI | 1801342092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT033279) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01678500) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2025-07-15 |