| NPI | 1568843639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 10601) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2108579) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2015-06-15 |