| NPI | 1265146153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00189100) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 48078) |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2023-01-06 |