| NPI | 1811297153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 4oqa01383200) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 4oqa01383200) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2018-12-30 |