NPI | 1659631570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01343300) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032107) |
Enumeration Date | 2012-05-24 |
Last Update Date | 2023-06-07 |