| NPI | 1356908974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: DE J2-0001211) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-05-20 |