| NPI | 1396977641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-02060) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2009032386) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2018-04-27 |