| NPI | 1255785176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160006631) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06004457A) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2016-04-18 |