| NPI | 1821032095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA00514500) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 40QA00514500) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-04-29 |