| NPI | 1487724183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 40QA00657600) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA00657600) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-07-30 |