| NPI | 1497126866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-02914) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NM A-1177) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2015-10-12 |