| NPI | 1871906321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NE 1183) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 0849) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2014-06-03 |