| NPI | 1902168669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 008793) |
| Additional Taxonomies | 171W00000X Contractor (Licence: TX 2061050) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-07-15 |