| NPI | 1194028308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI002801) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00215600) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2010-12-09 |