| NPI | 1417151622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ QA3103) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| 174400000X Specialist | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2022-12-30 |