| NPI | 1235905233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42364) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02227700) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2024-09-27 |