| NPI | 1861819070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01458900) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NJ 40QA01458900) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01458900) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2014-03-25 |