| NPI | 1134240450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: NJ 02521) |
| Additional Taxonomies | 2251N0400X Physical Therapist Neurology (Licence: NJ 02521) |
| 2251S0007X Physical Therapist Sports (Licence: NJ 02521) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: NJ 02521) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-10-24 |