| NPI | 1548373269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01279000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017782) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2013-04-22 |