| NPI | 1063960938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01709500) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT025587) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2024-10-30 |