| NPI | 1538687157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MD A4578) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WV 002326) |
| Enumeration Date | 2017-09-04 |
| Last Update Date | 2017-09-04 |