| NPI | 1881806271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NJ 40QA00274000) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NJ 40QA00274000) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2007-10-14 |