| NPI | 1922401371 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01563400) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01563400) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |