| NPI | 1265818918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306603167) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 66009042) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |