| NPI | 1023551140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN PTA0000005936) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A03070) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2016-11-21 |