| NPI | 1467524033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA01081200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ PTQA01081200) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2009-10-29 |