| NPI | 1881012490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT006349L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ CP049028T) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2025-09-12 |