| NPI | 1083142814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: HI PTA-360) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2083758) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2017-05-24 |