| NPI | 1427581305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC 6084) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 26867) |
| 225200000X Physical Therapy Assistant (Licence: SC 3735) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2017-04-06 |