| NPI | 1679874812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01464100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008910) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2021-04-21 |