| NPI | 1336321579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA AT8472) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 22048) |
| 225200000X Physical Therapy Assistant (Licence: TX 2075613) | |
| 225200000X Physical Therapy Assistant (Licence: IL 160.006036) | |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2012-11-28 |