| NPI | 1285963777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: UT 2852642402) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: ID PTA-266) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2009-12-14 |