| NPI | 1588924609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM A-0867) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 6783) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2018-12-27 |