| NPI | 1205672516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02261900) |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2026-06-15 |