| NPI | 1598951758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: GA AT001073) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA001317) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2007-09-21 |