| NPI | 1306064993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MT 1966) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 7347a) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2007-07-08 |