| NPI | 1083907018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00284500) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TEI002959) |
| 225200000X Physical Therapy Assistant (Licence: DE J2-0000867) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2012-10-23 |