| NPI | 1205166980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE002278L) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 161603) |
| Enumeration Date | 2010-01-03 |
| Last Update Date | 2010-01-03 |