| NPI | 1144601519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306604544) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2102139) |
| 225200000X Physical Therapy Assistant (Licence: CA 51203) | |
| 225200000X Physical Therapy Assistant (Licence: NY 009299) | |
| 225200000X Physical Therapy Assistant (Licence: MD A4358) | |
| 225200000X Physical Therapy Assistant (Licence: OR 09054) | |
| 225200000X Physical Therapy Assistant (Licence: GA PTA003958) | |
| 225200000X Physical Therapy Assistant (Licence: SC 4229) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-10-15 |