| NPI | 1093910424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OK 2349) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 200507435) |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2023-01-10 |