NPI | 1154877058 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01679300) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA01679300) |
2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01679300) | |
Enumeration Date | 2016-08-30 |
Last Update Date | 2016-08-30 |