| NPI | 1518327832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT36689) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01338200) |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2021-04-07 |