| NPI | 1861046864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01869700) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2021-10-05 |