| NPI | 1841500022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P100106E) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01377700) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01377700) | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2020-08-14 |