| NPI | 1821619875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-03677) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NV A-1181) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2020-04-30 |