| NPI | 1063605152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MS PTA2693) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: LA A7693R) |
| 225200000X Physical Therapy Assistant (Licence: LA CP017917A) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2023-03-12 |