| NPI | 1962872325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00291200) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2110741) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2016-11-14 |