| NPI | 1184903080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00278500) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 003507-1) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2011-08-09 |