| NPI | 1033690367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 115305) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-01045) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-08-24 |