| NPI | 1912139908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 006850) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 9027) |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2009-08-10 |