| NPI | 1730379918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2065299) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MS PTA4255) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2013-12-03 |