| NPI | 1902111883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ QA01310000) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA01310000) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2019-03-12 |