| NPI | 1750826392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00324300) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 009807-1) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2017-01-18 |