| NPI | 1477936409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NV A-0813) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 9798A) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |