| NPI | 1861605743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 831-019) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 631-019) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-02-01 |