| NPI | 1255666822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA Te008288) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TEI002553) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2021-01-22 |