| NPI | 1275695504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA00155800) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 003864-1) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2008-01-29 |