| NPI | 1346600095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2015028672) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA22925) |
| 225200000X Physical Therapy Assistant (Licence: KS 14-03010) | |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-02-23 |