| NPI | 1073859559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KY A02523) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 4880) |
| 225200000X Physical Therapy Assistant (Licence: TX 2078290) | |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2013-01-02 |