NPI | 1548411366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01295100) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01295100) |
Enumeration Date | 2008-10-10 |
Last Update Date | 2020-08-03 |