| NPI | 1043580947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 08896) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06004037A) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2012-12-04 |