| NPI | 1427366178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27836) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00880100) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2021-09-09 |