| NPI | 1871603761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1391782) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00768800) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-09-27 |