| NPI | 1366895021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 8388422) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CT 001538) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |