| NPI | 1043312325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00288000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00408400) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2023-05-26 |