| NPI | 1578093993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01729500) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2020-05-06 |