| NPI | 1720467020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00308200) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 009595-1) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2015-05-20 |