| NPI | 1235535980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 009318) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE009863) |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2014-11-07 |