| NPI | 1871024075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 23157) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 5897) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |