| NPI | 1548653645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2088579) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: UT 6052348-2402) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2015-03-13 |