| NPI | 1902806367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32010) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT005649L) |
| 225100000X Physical Therapist (Licence: NJ 40QA00339700) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2023-04-20 |