| NPI | 1558697623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IN 06000701A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A00281) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2009-10-26 |