| NPI | 1699149831 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00245400) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 3876) |
| Enumeration Date | 2015-11-28 |
| Last Update Date | 2015-11-28 |