| NPI | 1043477979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN 7943) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 8620) |
| 225200000X Physical Therapy Assistant (Licence: ID PTA-179) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2021-09-17 |