| NPI | 1134618135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2137133) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 6546) |
| 225200000X Physical Therapy Assistant (Licence: NY 010654) | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |