| NPI | 1598074932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2078690) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 007490-1) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2010-10-04 |