| NPI | 1831370766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A3922) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 006709) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2007-11-20 |