| NPI | 1013179803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502006380) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 2007-19) |
| 225200000X Physical Therapy Assistant (Licence: TN PTA0000003525) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2022-02-11 |