| NPI | 1750532685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NM PTA1018) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 1393-019) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2020-11-05 |