| NPI | 1720588304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160.007924) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IL 043112534) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-02-20 |