| NPI | 1861902397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: ID 3291) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 09542) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |