| NPI | 1699061630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT37950) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23701) |
| 225100000X Physical Therapist (Licence: NJ 40QA01518900) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2024-04-10 |