| NPI | 1548621964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TEI003418) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 3140) |
| Enumeration Date | 2016-03-12 |
| Last Update Date | 2016-03-12 |