| NPI | 1396189338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01334800) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2023-03-29 |