| NPI | 1457591224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2069930) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 6192) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2009-03-05 |