| NPI | 1619061710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA00899200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00899200) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-08-11 |