| NPI | 1194948950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NV PT A-0429) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PT A-17349) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |