| NPI | 1386912004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AL PTA6816) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA 19511) |
| 225200000X Physical Therapy Assistant (Licence: GA PTA002697) | |
| 225200000X Physical Therapy Assistant (Licence: TN PTA0000002483) | |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2017-06-22 |