| NPI | 1215068119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IN 06002774A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A01862) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-07-08 |