| NPI | 1619513918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 50992) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00350600) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2021-04-07 |