| NPI | 1366463010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE1000243) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: DE J2-0000297) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2016-02-01 |