| NPI | 1063129237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00378400) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2025-05-14 |