| NPI | 1174827596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC A5243) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WV 001485) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2020-04-28 |