| NPI | 1033831342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02126800) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2022-10-01 |