| NPI | 1609260017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QBOO324400) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CT 001390) |
| 225700000X Massage Therapist (Licence: CT 002944) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2016-03-09 |