| NPI | 1578851283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: UT 8012655-2402) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: CO NA-152991) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2011-07-14 |