| NPI | 1285964957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY A02491) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06002965A) |
| Enumeration Date | 2010-01-02 |
| Last Update Date | 2010-01-02 |