| NPI | 1376936138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306603478) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A3863) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-03-17 |