| NPI | 1407111347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2088720) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2012-07-06 |