| NPI | 1609326545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303052) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01681300) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2025-04-21 |