| NPI | 1851639637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NV A-0817) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 9164A) |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2019-03-14 |