| NPI | 1750786406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NV A-0728) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 1954-19) |
| 225200000X Physical Therapy Assistant (Licence: CO 0013299) | |
| 225200000X Physical Therapy Assistant (Licence: OR 09039) | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2014-10-23 |