| NPI | 1033534896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01541600) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: NJ 40QA01541600) |
| 2251S0007X Physical Therapist Sports (Licence: NJ 40QA01541600) | |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2014-03-03 |