| NPI | 1891763850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 00529) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-07-08 |