| NPI | 1699140483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 9624A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NM A-0899) |
| Enumeration Date | 2015-12-06 |
| Last Update Date | 2015-12-06 |