| NPI | 1285907626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 9618A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 4607) |
| 225200000X Physical Therapy Assistant (Licence: TX 2083653) | |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2012-02-15 |