| NPI | 1932653813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01709800) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT025460) |
| 225100000X Physical Therapist (Licence: NJ 40QA01709800) | |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2021-10-29 |