| NPI | 1609057553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01251100) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01251100) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2021-09-10 |