| NPI | 1588976278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2005014828) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 1401738) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2010-07-09 |