| NPI | 1346705803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00317700) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 40QB00317700) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2019-02-08 |