| NPI | 1861599250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA00640100) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 012703-1) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-10-02 |