| NPI | 1508494139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ CP044874T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT293641) |
| 225100000X Physical Therapist (Licence: AZ LPT-32043) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-06-03 |