| NPI | 1306873310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA000430) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN PTA0000000881) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2007-07-08 |