| NPI | 1609135227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: UT 8187123-2402) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL PTA6341) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2012-05-16 |