| NPI | 1801262894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00249500) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2102738) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-08-13 |