| NPI | 1922267780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE005750L) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00206900) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |