| NPI | 1972995454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NJ 40QA01562000) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01562000) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2020-12-01 |