| NPI | 1538538913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2090772) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A5024) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2018-10-19 |