| NPI | 1316302391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 005035) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2110469) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2015-12-17 |