| NPI | 1245483403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 00420) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 561) |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2008-10-30 |