| NPI | 1033843255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41463) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02096400) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2025-02-18 |