| NPI | 1780030551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 10436) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO 0013069) |
| 225200000X Physical Therapy Assistant (Licence: HI 253) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2016-05-10 |