| NPI | 1336532951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2124791) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-02828) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2016-09-08 |