| NPI | 1003341629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A5280) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 09463) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |