| NPI | 1902973944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA00221500) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00180800) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-01-25 |