| NPI | 1285909507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35221) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01437200) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2020-01-07 |