| NPI | 1184178535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-03054) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306604493) |
| Enumeration Date | 2016-08-14 |
| Last Update Date | 2016-08-14 |