| NPI | 1427423235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 26282) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2117343) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2015-12-04 |