| NPI | 1619933017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT22704) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA01126700) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01126700) | |
| 2251S0007X Physical Therapist, Sports (Licence: FL PT22704) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2011-05-31 |