| NPI | 1235431586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA01526700) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01526700) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2013-11-22 |