| NPI | 1376014597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2142558) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MS PTA6244) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-17 |