| NPI | 1912307554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02393800) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2026-01-14 |