| NPI | 1558870519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: 47897) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2018-03-17 |