| NPI | 1073639639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: RI 00633) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 2517) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-08 |