| NPI | 1073783833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2005031948) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160.000148) |
| Enumeration Date | 2008-03-08 |
| Last Update Date | 2008-03-08 |