| NPI | 1881926434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CT 752) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 3102) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2010-02-08 |