| NPI | 1255661575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160.004786) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA20840) |
| 225200000X Physical Therapy Assistant (Licence: MO 2004035466) | |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2010-01-08 |