| NPI | 1164766895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160005950) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NM A-0816) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2012-11-19 |