| NPI | 1104165737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 7981) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2015-10-26 |