| NPI | 1508127713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01245900) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 7268) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2012-06-04 |