| NPI | 1114950961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40349) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00396700) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-09-29 |