| NPI | 1922567635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01753700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026723) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2026-09-10 |