| NPI | 1164634671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2058260) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CT 000861) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2007-07-08 |