| NPI | 1043631815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2086970) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE009197) |
| Enumeration Date | 2013-12-22 |
| Last Update Date | 2013-12-22 |