| NPI | 1588980452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 007369-1) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL pta21430) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2010-04-15 |