| NPI | 1760714463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA02080100) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NJ 25MZ00072400) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2022-03-28 |