| NPI | 1124081088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT36857) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA005178) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2024-09-03 |