| NPI | 1851836803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 1402946) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 2012038311) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2016-12-29 |