| NPI | 1205018256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI002499) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ pta40QB00242200) |
| Enumeration Date | 2007-12-02 |
| Last Update Date | 2014-08-03 |