| NPI | 1043814536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36890) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NJ 40QA01979600) |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2022-08-23 |