| NPI | 1427314319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI003480) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA Te009147) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2015-12-03 |