| NPI | 1457786287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00187900) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 6121) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2013-09-11 |