| NPI | 1578872198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-02179) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 1-02815) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2013-01-04 |