| NPI | 1710025945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00486500) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA00486500) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2021-11-17 |