| NPI | 1710380837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00312400) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE010029) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |