| NPI | 1821301805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A4357) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 006958) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2010-07-20 |