| NPI | 1790158624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC 5654) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2116150) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2015-10-30 |