| NPI | 1649377888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502000374) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-03-02 |