| NPI | 1730387739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01251600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PTO017218L) |
| 225100000X Physical Therapist (Licence: PA PT017218) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2011-08-29 |