| NPI | 1801140066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502001852) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 006684) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |