| NPI | 1023403169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NV A-0373) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 4595) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |