| NPI | 1497099543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 247647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA01123700) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2026-03-17 |