| NPI | 1912108614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01097000) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: PA PT014194L) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-09-11 |