| NPI | 1942383039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 31651) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00452300) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-12-08 |