| NPI | 1013244953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306001070) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A2859) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2020-12-12 |