| NPI | 1023265063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM A-0640) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 806) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-10-11 |