| NPI | 1811105158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 6591) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A02256) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |