| NPI | 1134511165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 25265) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 3182) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2015-02-27 |