| NPI | 1821296112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE006758) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00226300) |
| 225700000X Massage Therapist | |
| Enumeration Date | 2007-07-07 |
| Last Update Date | 2007-07-08 |