| NPI | 1780708990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: DE J2-0000404) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE007091) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-08 |