| NPI | 1134246911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC 1471) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA 1574) |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2007-07-08 |