| NPI | 1265889125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MT PTP-PTA-LIC-9421) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: UT 8256936-2402) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2016-05-20 |