| NPI | 1710910112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028006) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38484) |
| 225100000X Physical Therapist (Licence: NJ 40QA01591600) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2023-08-29 |