| NPI | 1811228828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2074380) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR 2368) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2010-01-15 |