| NPI | 1609071737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01307100) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 022787-1) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2017-04-25 |