| NPI | 1649767427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN PTA0000005266) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A02948) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2018-04-17 |