| NPI | 1558445155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QAO3536) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: NJ qa03536) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ QA03536) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-10-11 |