| NPI | 1285889899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A3488) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC A3869) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2010-10-15 |