| NPI | 1083667547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00440200) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: NJ 40QA00440200) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NJ 40QA00440200) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NJ 40QA00440200) | |
| 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA00440200) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA00440200) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2010-01-21 |