| NPI | 1982305868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP048244T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02162600) |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2025-10-16 |